Early Dietary Exposures and Feeding Practices

Abstract
Food allergy prevalence varies geographically and appears to be increasing in “westernized” areas.(1) This lecture focuses on the role of early dietary exposures (infant feeding) and feeding practices (timing and types of foods chosen) on food allergy. Recent Guidelines from the US have addressed diet as a means of allergy prevention.(2;3) Emphasis is placed upon encouraging breast feeding and considering the use of “hypoallergenic” infant formulas for infants “at risk” if the infant is not breast fed. New guidelines in the US rescind prior recommendations that suggested avoidance of potentially allergenic foods for prolonged periods in infants at risk; for example prior suggestions to avoid milk until age 1, egg until age 2 and fish, peanut or nuts to age 3 years. The reversal substantially matches approaches that were in place in most countries outside of the US. Study after study appears to be substantiating the impression that waiting longer to introduce dietary “allergens” may be counterproductive for atopy outcomes (e.g., (4-7) and others). There are likely numerous dietary reasons, besides dietary allergen exposure per se, that can affect allergy outcomes.(8;9) We will explore how feeding practices themselves (using manufactured foods, cultural and regional differences) may have influenced allergy outcomes as well.

(3) Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic
disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction
of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121(1):183-91.